Qui Tam Whistleblower Lawyer
Fraud costs the Military Health Insurance Program more than $100 Million
Category: Settlements and Verdicts
The United States military's health insurance program has been defrauded for more than $100 million during the past 10 years. Doctors, hospitals and clinics in the Philippines have plotted with U.S. veterans to submit false health claims.
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Medicaid Fraud Allegations Settle, Walgreens Pays $35 Million
Category: Settlements and Verdicts
The Pharmacy America Trusts settled allegations by a whistleblower pharmacist by paying $35 million. The suit alleged that Walgreens knowingly defrauded Medicaid by switching prescriptions for ranitidine, the generic form of the brand-name drug Zantac®, and fluoxetine, the generic form of Prozac®.
Qui tam Relator Bernard Lisitza, on behalf of the United States, 42 states and Puerto Rico, alleged that Walgreens unlawfully caused its pharmacies to switch prescription Medicaid patients from ranitidine tablets to ranitidine capsules, and from fluoxetine capsules to fluoxetine tablets.
The alleged fraud lasted for more than four years, from July 16, 2001 through December 31, 2005. The Relator brought the Complaint in 2003, under qui tam provisions of federal and state False Claims Acts.
The investigation and prosecution was led by the Attorneys General of the 42 states. Relator Lisitza pursued the case with the assistance of his attorneys, Michael I. Behn and Linda Wyetzner, of Behn & Wyetzner, Chartered, Chicago.
Four Florida Men Charged With $110 million In False Medicare Claims
Category: Settlements and Verdicts
Carlos, Jose and Luis Benitez, along with Thomas McKenzie, a physician's assistant, were charged with money laundering by the Department of Justice's Criminal Division and the U.S. Attorney's Office for the Southern District of Florida. The four allegedly made more than $110 million worth of false claims to Medicare between 2001 and 2004.
According to the indictment, two of the brothers, Carlos and Luis Benitez, paid Medicare beneficiaries at eleven clinics they oversaw to submit claims for HIV infusion services that were neither provided nor medically necessary. The physician's assistant, Thomas McKenzie, allegedly trained staff on how to prepare and submit false claims to Medicare.
Prosecutors in this case asked that the suspects receive up to 155 years imprisonment for Carlos and Luis Benitez, the maximum sentence of 40 years of imprisonment for Jose Benitez, and 50 years for Thomas McKenzie.
Philadelphia U.S. Attorney Announces $700,000.00 Settlement Linked To Personal Care Facilities
Category: Settlements and Verdicts
Pat Meehan, U.S. Attorney in Philadelphia, announced that his office has reached a $700,000 civil settlement with Ivy Ridge Personal Care Center, Inc., Brookwood Personal Care Home, Inc., Conlyn House, Inc., Throughgood, Inc. Health Horizons Unlimited, Inc. and owner Rosalind S. Lavin.
No More Medicaid Reimbursements in New York for Avoidable Errors and "Never Events"
Category: Qui Tam Legal News
Commencing in October 2008, New York hospitals will be denied reimbursement on 14 "never events" from the New York Medicaid program. "Never events" are defined as (a) avoidable hospital complications, including medical errors, (b) which are serious in consequences to patients, that are (c) identifiable and (d) preventable. In his announcement of the change, state Health Commissioner Richard F. Daines, M.D. stressed that this policy been put in place to improve healthcare quality, reduce medical errors and ensure patient safety.
Lockheed Martin Pays $10.5 Million to Settle False Claims Act Case
Category: Settlements and Verdicts
Lockheed Martin Space Systems, a Denver-based division of Lockheed Martin Corporation, has settled a False Claims Act case for $10.5 million resulting from allegations that Lockheed had submitted invoices for payment it was not entitled to receive.
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Bristol-Myers Squibb Co. ("BMC"), and its subsidiary, Apothecon, agreed to pay $515 million to settle allegations relating to pricing practices and drug marketing.
Category: Settlements and Verdicts
According to the government, BMS paid illegal kickbacks to physicians from 2000 to mid-2003, in order to get the physicians to promote BMS drugs. These payments were in form of consulting fees and other programs, of which some involved travel to extravagant resorts.
Allegations centered around the use and sale of the drug Abilify, an atypical antipsychotic drug. BMC allegedly encouraged Abilify's use as a pediatric drug and for dementia-related psychosis, both of which are "off-label" uses. A drug's use is considered off-label when it has not been approved by the FDA for that particular use. Here, Abilify has been approved to treat adult psychiatric disorders but not for the use in children or teenagers or for dementia-related illnesses.
Although doctors are permitted to prescribe drugs with or without FDA-approval for that particular use, companies are forbidden to promoted drugs for off-label uses.
U.S. Achieves $6.7 million settlement in healthcare fraud case in Florida.
Category: Settlements and Verdicts
On May 12, 2008, Broward County doctor, Aleyda Borge, M.D., along with the operators of Leonza Health Management Group, settled with the federal government for $6.7 million on allegations of healthcare fraud.
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Three Miami Doctors and Six Others Charged in $56 Million HIV Infusion Fraud Schemes
Category: Settlements and Verdicts
On May 30, 2008, the Criminal Division of the Department of Justice and the Attorney General's office released a statement indicating that three doctors and six other individuals that have been charged in four different indictments for involvement in a $56 million HIV infusion fraud scheme.
McKesson Corporation to Pay Over $13 Million to Settle Allegations It Violated Federal Reporting Requirements
Category: Settlements and Verdicts
Without admitting liability, McKesson Corporation, a national distributor of prescription medications, has settled a claim for violating federal reporting requirements related to the sale of prescription medications. McKesson has agreed to pay $13,250,000 in civil penalties under an agreement between McKesson and multiple U.S. Attorney's Offices, including the District of Maryland.
National City Mortgage Settles False Claims Act Case for $4.6 Million
Category: Settlements and Verdicts
Direct Endorsement lender National City Mortgage (NCM), based out of Miamisburg, Ohio, is paying the United States $4.6 million based upon the False Claims Act, to settle allegations relating to mortgage fraud. The settlement was announced by PRNewswire on May 22, 2008.
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FBI releases annual healthcare fraud statistics and information
The FBI recently published its annual Financial Crimes Report to the Public for the Fiscal Year 2007, showing that health care fraud is of continued concern.
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Pharmacy owner faces up to 130 years in prison for his part in $3m Medicare fraud
Category: Settlements and Verdicts
A Miami jury found Gustavo Smith, 43, guilty of all 17 counts charged against him in the September 2007 indictment, including: conspiracy to defraud the U.S. government, to commit health care fraud, and to submit false claims to the Medicare program; seven counts of health care fraud; seven counts of submitting false claims to the Medicare program; conspiracy to commit money laundering; and one count of money laundering. Sentencing has been scheduled for July 2, 2008.
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$1.1 Million settlement for False Claims Act violations entered against psychiatrist for billing fraud
Category: Settlements and Verdicts
$1.1 million consent judgment has been entered against Cleveland psychiatrist Gulshan Sultan to resolve claims against her for alleged violations of the federal False Claims Act and the Tennessee Medicaid False Claims Act.
OIG's 2008 Workplan focuses on diagnostic imaging and durable medical equipment
Category: Qui Tam Legal News
Several areas of imaging facilities were placed on OIG's 2008 workplan....
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Miami's Medicare Strike Force Scores Another Conviction
Category: Settlements and Verdicts
A Miami federal jury has convicted a physician and the owners and operators of two durable medical equipment companies as well as a home health care agency of Medicare fraud.
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Failure to Follow Kevlar Specifications Nets $1.9 Million
Spirit Lake Tribe recently agreed to pay $1.9 million following allegations that it failed to follow specifications in making Kevlar cloth material. The material was used for miliatry helmets worn by U.S. soldiers fighting in Iraq and Afganistan.
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Congress Begins third attempt to stop Federal Circuit's hostility to whistleblowers
Category: Legislative Updates
A review of all whistleblower decisions by the Federal Circuit from October 1994 to October 2007, conducted by the Government Accountability Project (GAP), confirmed the feeling of many attorneys who work in the arena of the Federal Whistleblower Protection Act: that the Federal Circuit has a record of hostility to such cases...
Alabama AG announces $6.75mm settlement
Category: Settlements and Verdicts
Alabama Attorney General Troy King announced January 9, 2008 that the State has settled claims against pharmaceutical manufacturers Dey, LP and Takeda Pharmaceuticals North America, Inc. for $6.75mm...
HealthSouth and Physicians Pay $14.9 Million to Settle Health Care Fraud Claims
The Department of Justice announced in mid-December that Birmingham-based HealthSouth Corporation and two physicians have agreed to pay the United States a total of $14.9 million to settle allegations that it violated the False Claims Act and paid illegal kickbacks to physicians who referred patients for care in some of its hospitals, outpatient rehabilitation clinics, and ambulatory surgery centers.
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Hospital Agrees to Pay $7.5 Million for Medicare Overbilling
Category: Settlements and Verdicts
Warren Hospital, headquartered in Phillipsburg, has agreed to pay the United States $7.5 million to settle allegations that it defrauded the federal Medicare program...
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Senate Extends Whistleblower Protection
Category: Legislative Updates
On December 18, 2007 the Senate unanimously passed its version of a law that will enhance whistleblower protections for federal employees. The Federal Employee Protection of Disclosures Act (S.274) enhances the protection of federal employee whistleblowers who report wrongdoing within their chain of command. The law will now go to conference to be reconciled with the House version (H.B.985) which passed in March 2007.
The law should be a start toward overturning the Supreme Court decision of Garcetti v. Ceballos which held that when a whistleblower has an employment duty to report wrongdoing, the First Amendment does not protect the employee against retaliation by their employer. Under the new law, federal employees reporting such wrongdoing within their chain of command are protected in so doing.
Unfortunately, Garcetti v. Ceballos will still apply to state employees.
Medicare Fraud Strike Force Recovering Millions
Southern District of Florida's U.S. Attorney, R. Alexander Acosta, announced recently that the South Florida Medicare Fraud Strike Force has uncovered schemes to falsely bill Medicare of more than $600 million. The strike force, consisting of four full-time attorneys, along with the FBI, Centers for Medicare and Medicaid, and the Florida Department of Health, has almost quadrupled the number of those charged with filing false claims the year of 2007.
United States Sues Tenet's Former General Counsel for False Claims Act violations
Former General Counsel of Tenet Healthcare Corp. Christi Sulzbach is charged with allowing the company to illegally bill Medicare for its South Florida hospitals in 1997 and 1998 by submitting false certifications that allowed Tenet to bill Medicare for claims it should not have received.
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Makers of Vioxx Sued for Medicaid Fraud under New York FCA
Category: Qui Tam Legal News
In the first New York state False Claims Act case, Attorney General Andrew M. Cuomo and New York City Mayor Michael Bloomberg have filed a joint suit against Merck & Co. alleging it actively marketing the drug Vioxx to New York doctors while misrepresenting the drug's dangers, causing Medicaid to spend over $100 million on Vioxx prescriptions between 1999 and 2004.
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